Chapter 17: Cardiovascular Emergencies - Part 3

Key Topics Covered:

• Dysrhythmias Interpretation
• Treatment of Dysrhythmias

Dysrhythmias Interpretation Approaches

1. ECG Strip Analysis

   • Identify P, Q, R, S, T waves
   • Measure PR Interval
   • Measure QRS Duration
   • Determine Rhythm Regularity
   • Measure Heart Rate

2. Rhythm Regularity

   • Regular: Equal distance between R waves
   • Irregular: Varying distance
     • Irregularly Irregular
     • Regularly Irregular

3. Heart Rate Measurement Methods

   • Six-Second Method: Count QRS in 6 sec strip, multiply by 10
   • Sequence Method: Use large box count (300, 150, 100, etc.)
   • 1500 Method: Count small boxes, divide by 1500

Specific Cardiac Dysrhythmias

• Premature Complexes: Premature impulses can cause interference
• Disturbances:
  • Automaticity
  • Conduction
  • Tachydysrhythmias (Fast)
  • Bradycardias (Slow)

Sinus Node-Originated Rhythms

• Normal Sinus Rhythm: 60-100 bpm, regular RR intervals
• Sinus Bradycardia: <60 bpm, may cause symptoms
• Sinus Tachycardia: 101-180 bpm, caused by various stressors
• Sinus Dysrhythmia: Rate variation with respiration
• Sinus Arrest: SA node fails temporarily

Management of Bradycardia

• Goals: Adequate oxygenation, ventilation, perfusion
• Emergency Care: Maintain airway, assist breathing, use cardiac monitor
• Treatments: Administer Atropine, consider pacing

Artificial Pacemakers

• Transcutaneous Pacemakers: External electrical impulse delivery
• Capture: Depolarization response on ECG

Atria-Originated Rhythms

• Premature Atrial Complexes: Early complexes within another rhythm
• Supraventricular Tachycardia (SVT): Fast rhythm from above ventricles
• Atrial Fibrillation (AFib): Atria quiver, risk of stroke
• Atrial Flutter: Rapid atrial rate
• Wandering Pacemaker: Multiple pacemaker locations

AV Junction-Originated Rhythms

• Junctional Rhythm: AV node acts as pacemaker
• Accelerated Junctional Rhythm: 60-100 bpm
• Junctional Tachycardia: >100 bpm, may require treatment

Ventricular-Originated Rhythms

• Premature Ventricular Complexes (PVCs): Early complex, common in heart disease
• Idioventricular Rhythm: Ventricles pace heart in absence of SA/AV node
• Ventricular Tachycardia (VTac): Fast rate, can lead to serious issues
• Ventricular Fibrillation (V-Fib): Heart fibrillation, requires defibrillation

Treatment and Care

• Defibrillation: For V-Fib and pulseless VTac
• AEDs: Automatic rhythm analysis and shock delivery
• PEA (Pulseless Electrical Activity): Organized rhythm without pulse

Asystole and PEA Management

• Asystole: No electrical or mechanical activity
• PEA: Requires identification and treatment of underlying cause

Conclusion

• Part 3 focused on dysrhythmia interpretation and emergency management.
• Next, part 4 will cover cardiac arrest management and related algorithms.